I get loads of calls and emails every month for advice on how to find the best therapeutic boarding school. Unfortunately, there is no one-stop shopping list of schools so I’ve done my best to list them all out below. I’m sure I’ve missed some. By the time this is posted, there will probably be a few new ones that pop up, a few that changed their name or got gobbled up by a big company. If you have updates, feel free to email me and I’ll post the new info here. This is not meant to be an endorsement of these programs, just a list. As I visit schools that do great work, I generally will do a blog post about what I’ve found and why I like what they’re doing.

“He’s driving us insane, clearly needs help but almost finished classes. When should we place him in residential treatment?”
My client’s mother summed it up perfectly. Their son was not in danger, he was making decent grades but definitely needed more help than what we could provide at home and in an outpatient setting (eg. individual therapy), so what was a family to do when there are holiday parties, family coming into town and gifts to exchange?

Let’s organize this and then we’ll have an answer.

Safety: If there is an imminent (immediate) safety issue like plans for suicide, extreme drug use or some other acute issue, placement happens asap. The family and friends will all understand if plans change, especially if they know your son or daughter needed help. If safety is an issue, contact a therapeutic placement consultant or educational consultant to help navigate the process. It can get more complicated than one would imagine. Has your kid been to the hospital? Do they have a psychological evaluation? Is there a summary from his or her therapist about diagnosis, prognosis and treatment recommendations? Have you contacted your insurance company about coverage for care? Trust me…don’t go it alone.

If there is no safety issue but there is a chronic issue (eg. ongoing pot use, bad grades, acting out behaviors), the difference between placing your son or daughter now versus the week after New Years is probably negligible.

Money: Sometimes, families need to wait until the new year for tax or financial purposes. Sometimes, the opposite is true – they need to use up money in an HSA or FSA before the end of the year or they are trying to capture some medical deductions. I always ask parents to consider the pros and cons from a financial perspective, not just behavioral health needs.

Availability and Timing: Therapeutic boarding schools, wilderness therapy programs and residential treatment programs often have waitlists in late Fall. Many families try to pull their kids around the holidays either because they’ve met the treatment goals or, the parents just can’t imagine the family gathering without their kid. This pattern can be used to figure out the best time for a kid to start a program. If things are really bad at home and the kid’s behavior warrants it, the week between Christmas and New Years can be a great time for placement since there are more openings in programs. Another good week is immediately following New Years.

Another consideration is school or important activities. If a kid is just about finished a semester at college or has a week of high school classes remaining, pulling them from school may not have a high return on investment. Again, are their significant enough clinical or safety issues that trump their need to complete classwork?

Discussion: More often than not, I’m coaching parents on how to hand responsibility and control over to their kids. But when it comes to therapeutic placement, I recommend a more conservative approach with a ‘need to know’ mentality. Just because the treatment will directly impact your son or daughter doesn’t necessarily mean they should get a vote in whether they go or not. In most instances, I don’t even recommend disclosing or discussing the idea of higher level of care. Once a decision is made by parents that the kid will be going to therapeutic placement of some sort, life should go on as normal as possible until the day of admissions. “But how do you get a kid to go to treatment if they are never told about it?” Most of the time, I recommend they are escorted by therapeutic transport from home to the program. Parents stay behind and follow-up later eithe by phone of a later visit. Most program also prefer parents not participate in intake. Engagin in therapeutic placement is always hard, but having parents try and escort their own kid makes things WAY harder.

Decision: You only need to be 80-90% decided on therapeutic placement for your kid to move forward. Rare are the parents whom feel 100% certain it’s the right decision. Yes, your kid will hate you (for about two weeks). Yes, you will cry and feel like terrible parents. Yes, you will feel powerless in the first few weeks. But this is what’s necessary to get through the process which can have life-changing impact. You may not have chosen for your son or daughter to abuse pot, get bad grades, and not be able to fully engage in life, but you do have a choice on how to fix things.

There’s never a perfect time to make tough choices but hopefully my insights can help your family figure out if and when to find care for your struggling teen or college kid.

http://fonthillbehavioralhealth.com/wp-content/uploads/2016/08/Fonthill-Behavioral-Health-midsize-300x50.png00Rob Danzman, MS, NCC, LPChttp://fonthillbehavioralhealth.com/wp-content/uploads/2016/08/Fonthill-Behavioral-Health-midsize-300x50.pngRob Danzman, MS, NCC, LPC2017-12-16 18:01:232017-12-16 18:01:23Insider's Guide: The If and When for Therapeutic Placement During the Holidays

This is a review from the article The Sneaky Way Colleges Try To Sell Students Health Insuranceby Ann Brenoff at the Huffington Post from October 10, 2017. Here are the Highlights:

Students must have insurance to be in school. Not only do students need insurance, they need insurance that meets the school’s minimum coverage standards. This standard is different from school to school.

College health plans are often already on the tuition bill. This is a classic aggressive marketing technique of forcing a customer to opt-out rather than opting in. Students must request a waiver if they have insurance that already meets the school’s requirements. A request is just an application, not a guarantee the student will be granted the waiver.

Waiver’s must be requested every year. That’s right folks, not only do you have to opt-out from insurance, you have to opt-out each year.

Premiums vary from campus to campus and can inflate the cost of going to college significantly. There is no standard for premiums. The average cost is $1,500 and $2,500 per year.

There is often little choice. Schools often have one or very few health plans and often have health centers who do not accept anything other than the insurance they sell.

Rules for waivers vary. Some schools want to see low in-network deductibles while others want to ensure there are adequate in-network providers in the school’s area.

Students can take out loans (or use scholarship money) for insurance. Since insurance is a line item right next to tuition, loans and scholarships are fair game for paying for insurance.

Big impact on students if the Affordable Healthcare Act changes. If the employer mandate or the coverage for kids 26 and younger is removed, the burden of insurance will pass from the large employers to the students and their families.

My opinion of the article and it’s focus is that students should definitely be mandated to have insurance while at school but there should be government oversight for what insurance is offered, how it’s disclosed to students and what provider options exist in the school’s area. Right now college insurance seems like the unregulated wild west and most families don’t even realize it. When we pay for something, we should have a right to know what we’re paying for and not be forced to opt-out. Often, this insurance payment is in addition to a ‘Health Fee’ which covers minor health and wellness interventions. For example, here at Indiana University’s counseling center (CAPS), there is a $30 fee for each session during each semester after the first two ‘free’ sessions. IU does not accept insurance and offers to provide an itemized invoice that can be sent to a student’s insurance company so the family can be reimbursed.

I recommend that if you have a kid that’s heading off to college next Fall and will likely need healthcare support for medical or mental health, do your homework to find out whether their health centers accept your insurance. Research how to complete the waiver and make sure you know how much out of pocket healthcare expenses could be.

Financially Better for Clients. This maybe counterintuitive, but paying out of pocket for many healthcare services has been shown to actually be the same or less expensive. The average number of sessions I see clients in a year is 21. Here’s the math: 21 Sessions x $159/session = $3339. That’s a big chunk of money. But…whatever is not reimbursable to you by insurance is often tax deductible. Most healthcare expenses can also be paid directly with an HSA or FSA. Additionally, more and more families are choosing high deductible, lower fee plans. Pay $5000 deductible and then insurance kicks in. That’s after you’ve paid your $833/month.

Less Complication. It takes longer to verify insurance, verify their plan covers my services and ensure they can be seen It is a fact that every document or form that needs to be sent to insurance is an opportunity for them to avoid financial responsibility. I’ve had dozens of situations where my office manager would send in a form and the insurance company would first claim they never got it. We’d resend it. Then they claimed it was not completed correctly. Resend after corrections. Then they would claim it was incomplete. This game can last up to a year (I’m still getting payments from insurance claims filed over a year ago).

Clinical Decisions are Not Driven By Insurance. I’ve had way too many instances where an insurance company told me or the family that the client ‘no longer met criteria for services.’ What? How the heck would they know that? It’s based on the number of sessions they allot, the diagnosis I gave and how much money has been spent. At no time does insurance actually review my notes, talk to the client or family or inquire about the clinical status. No thanks – I don’t want insurance professionals making decisions for my clients. And just in case you were thinking it, I’m not a right-wing, libertarian nut job. This is actually my progressive, liberal side coming out advocating for my clients against huge companies whose sole business model is to take in as much money as possible and avoid contractual obligations.

Flexibity. No insurance company has ever liked hearing that I’m on-call for clients and use texting, video chat, etc. to continue treatment and support between sessions. They also are not fans of me working with parents in a consulting manner. They don’t want to hear that I provide insider knowledge of treatment programs. None of this fits within their narrow definition of what a counselor should do. I do what is necessary to create stability and promote a healthier life.

Protection. Until there are safeguards that protect clients from being blacklisted for a preexisting condition (ACA is currently under attack from the Trump administration for this) I’d prefer not be forced by insurance companies to diagnose a client. For me to get payment, I have to provide client’s name, diagnosis code, CPT code (what service I provided), my license information, and my NPI (national identifier for healthcare professionals). If I fail to provide any of that, the claim with be denied. In my opinion, there is no reason why a company needs evidence that a client has a diagnosible condition. I totally understand requiring all the other information but diagnosis is unnecessary. At times, a diagnosis is important for the client or family to hear and understand.

For years I’ve been talking about the unethical and illegal means by which mental health and substance abuse treatment centers advertise to and treat clients. And now, finally, in one of the most accurate portrals of the industry, The Verge published a fantastic piece on the aweful practices large addiction treatment centers. From the manipulative call centers to terrible and dangerous clinical work, Cat Ferguson (freelance reporter based in California) exposed the seedy underbelly of this mostly hidden industry, predominantly in Florida. She focuses on Aid in Recovery, a sketchy hotline with a bazillion different phone numbers and websites (all of which are owned by a parent company Treatment Management Company) that funnel prospective clients (with good insurance!) to one of their affiliated treatment centers around the country. AIR is not unique. Hundreds of huge companies fight, cheat and steel every day for referrals. My one critique is that Cat didn’t pull in examples from the mental health treatment centers which are as aggressive and sketchy. Same bad actors engaging in greedy behavior to get clients.

The article reaffirms why it’s so important to work with a therapeutic placement consultant or educational consultant who knows what to avoid and how to find the most effective treatment. Not a sales pitch – just a fact that a good consultant can sniff out the industry bullshit from a mile away.

Most people see a psychotherapist/counselor for the mental benefits of having someone to talk to about anxiety, depression, relationship issues or substance abuse. Insurance companies have increasingly become difficult to work with and will often dictate types of treatment, how many sessions are allowable. They also dictate when someone is well enough to not need treatment. More and more students I work with at Indiana University are paying out of pocket for mental health services because of the hassles of dealing with insurance. Same is true for parents with whom I consult for therapeutic placement. Private pay, while seemingly more expensive on the front-end, turns out to often be comperable to using insurance.

What many people do not realize is that seeing a therapist or paying for residential treatment out of pocket can often be covered through out of network benefits and also might also provide tax deductions. To start the conversation, I put together a quick overview of what, if anything, can be deducted from your taxes.

Read on to learn when and what could be deductible. This may get more complicated if you consider using a health savings plan or flexible spending account to pay for services. Let’s get started…

1. Find those Qualifying Expenses

Only medical expenses that are for the “diagnosis, cure, mitigation, treatment, or prevention of disease, or payments for treatments affecting any structure or function of the body” are considered qualifying expenses. Your son or daughter’s therapist appointments are deductible as a medical expense, according to IRS Publication 502, but only to the extent it is for medical care. You can also include the cost of therapist appointments for your spouse or your dependents, if applicable.
Below is a partial list directly from the IRS site (I took the liberty of underlining some of the more relevant items):

Acupuncture

Air conditioner necessary for relief from allergies or other respiratory problems (less any increase in the value of your home resulting from installation of air conditioning)

Alcoholism treatment, including inpatient treatment, meals and lodging at a therapeutic center for alcohol addiction

Artificial limbs

Artificial teeth

Birth control pills prescribed by a doctor

Braille books and magazines used by a visually-impaired person

A clarinet and lessons to treat the improper alignment of a child’s upper and lower teeth

Contact lenses, including equipment and materials for using contacts

Cosmetic surgery, if it’s necessary to improve a deformity related to a congenital abnormality, accident or disease

Diet, special. When prescribed by a doctor, you can deduct the extra cost of purchasing special food to alleviate a specific medical condition

Doctor or physician expenses

Drug addiction treatment, including in-patient treatment, meals and lodging at a therapeutic center for drug addiction

Elastic hosiery to treat blood circulation problems

Exercise program if a doctor has recommended it as treatment for a specific condition

Extra rent or utilities for a larger apartment required in order to provide space for a nurse/attendant

Eye surgery, such as Lasik or a similar procedure, when it is not for cosmetic purposes only

Guide dog or other animal used by a visually-impaired, hearing-impaired or otherwise physically disabled person

Hospital care

Household help for nursing care services only

Insurance premiums for medical care coverage

Laboratory fees

Lead-based paint removal, including the cost of removing lead-based paints from surfaces when a child has lead poisoning or was previously diagnosed with lead poisoning. (Does not include the cost of repainting.)

Legal fees paid to authorize treatment for mental illness

Lifetime care advance payments

Lodging expenses while away from home to receive medical care in a hospital or medical facility

Long-term care insurance and long-term care expenses (there are limitations to what you can deduct)

Mattresses and boards bought specifically to alleviate an arthritic condition

Medical conference admission costs and travel expenses for a chronically ill person or a parent of a chronically ill child to learn about new medical treatments. (But not the cost of meals and lodging while attending the conference)

Medicines and drugs

Nursing care

Nursing home expenses, including the entire cost of medical care, plus meals and lodging if the main reason for being in the home is to obtain medical care

Oxygen and oxygen equipment

Reclining chair bought on a doctor’s advice by a person with a cardiac condition

Special education; tuition for sending a mentally impaired or physically disabled person to a special school that has resources to relieve the disability

Smoking cessation programs (does not have to be recommended by a physician)

Swimming (the cost of therapeutic swimming prescribed by a physician)

Telephone (the cost and repair of special telephone equipment for a hearing-impaired person)

Television (the cost of equipment used to display the audio part of a TV program for hearing-impaired persons)

Transplant of an organ (but not hair transplants)

Transportation costs for obtaining medical care

Travel expenses for parents visiting their child in a special school for children with drug problems, where the visits are part of the medical treatment

Weight loss program, if it is recommended by a doctor to treat a specific medical condition or to cure any specific ailment or disease

Whirlpool baths prescribed by a doctor

Wig for the mental health of a patient who has lost his or her hair due to a disease

X-ray services

Please also want to ask your tax professional how to also list expenses related to placing and working with therapeutic boarding school, education consultant, therapeutic transportation services, case manager, residential treatment center and inpatient hospitalization for any of your children that you listed as dependents and needed such care.

2. What Counts as Therapy (HINT: Not everything)?

The therapist’s treatment must be related to treating a physical or mental issue. For example, the IRS ruled that marital counseling to improve the marital relationship was not deductible as a medical expense since it was not related to a mental or physical defect (…which is why you should work with your therapist during the intake session to determine if you really need “marriage counseling” or individual counseling where you occasionally bring in your spouse to help with your distress). However, in other rulings, the IRS has held that the cost of psychiatric treatment for sexual inadequacy and incompatibility was closely related enough to a medical or physical defect that those costs could be deducted. This gray area comes up often which is why you should consult your tax professional AND therapist. Other types of therapy or intervention often over looked include:

4. Medical Deduction Limitations

Just because a therapist’s appointment qualifies as a medical expense doesn’t mean you will actually be able get credit for it on your tax return. In 2012, you could only deduct medical expenses that exceed 7.5 % of your adjusted gross income. For future years, the floor goes up to 10 %. For example, if your AGI is $51,000, using the 10 percent floor, you’re only able to deduct your medical costs that exceed $5,100. Unless you’ve got a very expensive therapist, you’re probably going to need some other medical expenses to be able to take any deduction.

5. Itemizing Required

If you take the standard deduction, you are out of luck. You must itemize your taxes in order to claim your therapist sessions (and any associated costs). If you can only deduct a few hundred dollars or so after accounting for the AGI floor, you might not benefit if you give up your standard deduction to itemize. However, if you were already planning to itemize because of other itemized deductions, such as the mortgage interest deduction or charitable contributions, any medical expenses can also be deducted without further cost.

Today I share some tips and tricks for finding a therapist from my upcoming book due out next year. Though I’m based in Bloomington, Indiana, I get calls and emails every week from parents all over the country looking for advice on how to find a therapist or counselor (or psychiatrist ). Whether your teen or college student is new to therapy or a seasoned client, finding a therapist can be confusing and frustrating. Follow my simple guide below to help.

*Head’s Up! I use the terms therapist, counselor and psychotherapist interchangeably since they are all essentially the same thing.

Online Search. Let’s start by looking through the granddaddy of databases like Psychology Today, NetworkTherapy, GoodTherapy, etc. These databases, while old fashioned and simplistic, are the most comprehensive listing of therapists in your area (I’ll go into more detail about online databases in an upcoming post). Unfortunately, they do a poor job of verifying specialties. So, for instance, you will find therapists that claim to treat all ages, all diagnoses (eg. Depression, Anxiety, Substance Abuse, Eating Disorders) and have expertise in all modalities (eg. DBT, CBT, Motivational Interviewing). I can assure you, they may have a basic understanding of those diagnoses and modalities, but they are far from deep experts.

Online databases are really good for two things:

Finding a therapist within your zip code

Finding a therapist that accepts your insurance

Another good (ok, somewhat good) resource is the database (normally online) kept by your insurance company. Most insurers have client/patient portals where you can look up all the therapists within a geographic area and, obviously, accept your insurance. They rarely have much detail about the therapist but at least you can confirm they are in-network.

Deciphering Credentials.While searching you will likely see a whole bunch of letters after someone’s name. That’s not just egomania about how smart they are – many licensing bodies require clinicians to list their degree (Masters, Doctorate or Medical Doctorate) as well as their license.
For example I’m required in North Carolina, Kentucky and Indiana to list myself in any professional and public manner as Rob Danzman, MS, LPC, LMHC. I have a Masters of Science (the MS) and am a Licensed Professional Counselor (LPC) as well as Licensed Mental Health Counselor (LMHC) overseen by the boards of licensed counselors in each state. Most licenses are administered by a state licensing board which is where you can go to a) verify a therapist’s license and b) file a complaint against a therapist if they did something wrong while working with you.

Here is a link in Indiana to verify my license. Just type my last name (Danzman) into the search box and click enter. You will see my license information pop up.

Here are a list of other credentials you may see after someone’s name and what they mean:

Now for a bit more detail on the most common types of mental health professional you’ll run into.

Psychiatrist

A psychiatrist is a physician (doctor of medicine [M.D.] or doctor of osteopathic medicine [D.O.]) who specializes in mental health. This type of doctor may further specialize in areas such as child and adolescent, geriatric, or addiction psychiatry. A psychiatrist can perform the following though they primarily prescribe medication:

Diagnose and treat mental health disorders

Provide psychological counseling, also called psychotherapy

Prescribe medication

Psychologist

A psychologist is trained in psychology — a science that deals with thoughts, emotions and behaviors. Typically, a psychologist holds a doctoral degree (Ph.D., Psy.D., Ed.D.). A psychologist:

Can diagnose and treat a number of mental health disorders, providing psychological counseling, in one-on-one or group settings

Vary in the services they can offer, depending on their education, level of training, experience and state law

Can assess, diagnose and treat mental illnesses, depending on their education, training and experience

Can prescribe medication in some states if they’re an advanced practice nurse

Physician Assistant

A certified physician assistant (P.A.-C.) practices medicine under the supervision of a physician. Physician assistants can specialize in psychiatry. These physician assistants can:

Diagnose and treat mental health disorders

Provide psychological counseling, also called psychotherapy

Prescribe medication

Licensed Clinical Social Worker

If you prefer a social worker, look for a licensed clinical social worker (L.C.S.W.) with training and experience specifically in mental health. A licensed clinical social worker must have a master’s degree in social work (M.S.W.), a Master of Science in social work (M.S.S.W.) or a doctorate in social work (D.S.W. or Ph.D.). These social workers:

Provide assessment, psychological counseling and a range of other services, depending on their licensing and training

Does not prescribe medication

May work with another provider who can prescribe medication if needed

Licensed Professional Counselor or Mental Health Counselor

Training required for a licensed professional counselor (L.P.C.) and (L.M.H.C.) varies slightly by state, but most have at least a master’s degree with clinical experience. These counselors:

Provide diagnosis and psychological counseling (psychotherapy) for a range of concerns

Does not prescribe medication

May work with another provider who can prescribe medication if needed

Background Checks. I’m not talking about running their info through the FBI to find out if they are criminals. When considering whether to work with a therapist, google their name, look up their info on the state licensing board’s website (if the state has one), and ask for clients or colleagues that could provide a referral. Asking for a referral is a bit unorthodox and most therapists wouldn’t know how to respond but it doesn’t hurt to ask. When perspective clients ask for referrals, I explain that because of HIPAA rules, I can’t just hand over a previous client’s contact info. What I can do is contact previous clients and ask if they would be willing to provide feedback to the perspective client. It’s tricky since I want to protect privacy and not put any sort of burden on the client.

Questions to Ask. Real simply put, you and your teen or college kid is interviewing someone to hire them for a job (counseling). Treat it like an interview and have a plan. Here are the list of questions you need to ask when considering whether or not to work with a therapist (print this off if needed):

What training do you have to treat the issues I described?

Please give me an example of how you would work with me on the issues I described?

What are your communication policies between sessions?

Have you ever had your license suspended or removed in this or another state?

How do you use technology in your practice? Is your agency able to provide weekly and 24 hr reminders prior to sessions?

If I need a different type of care or different level of care, what’s your experience in working with referral sources?

Are you in-network, out-of-network with my insurance? Do you have someone in your practice that files claims and works with insurance?

First Session. Show up early and come with any additional questions, concerns, goals or obstacles regarding your issues. I love it when parents show up with a page or more of thoughts, questions and random ideas. It not only helps me zero-in on a diagnostic impression but also helps me understand how the family operates and what their values are. If this is a session set up for your college kid, be confident and let the therapist know you want to sit in on the first 30 min to download some history and concerns from your perspective. It’s also a great time to sign a release of information so the therapist can legally speak with you between sessions. If the therapist is working remotely near campus in preparation for your kid to head back for the coming semester, make it clear you need to be kept in the loop and your son/daughter will be signing the release of information asap.

For more on finding a therapist, contact me with specific questions or ask to be put on the wait list for the book that covers this and just about every other topic parents of teens and college kids could need.

As excited freshman or experienced sophomores, juniors and seniors settle in for another Fall semester around the country, I wanted to put together a quick list of 7 things parents can do to hep their college kid suffering from anxiety. It’s scary to put so much freedom and responsibility into the hands of your son or daughter when you know worry and fear is always lurking around social, academic or career decisions. Before I discuss what to do about anxiety, I think it’s important to review some details about anxiety.

Everyone feels uneasy or anxious occasionally like when we are running late for a meeting or got caught doing something we’re not supposed to. It’s a normal.

Anxiety disorders are different than regular, situational anxiousness. They are a group of mental illnesses that are characterized by intensity, duration, origin and how they impact life domains like work/school, relationships, and health.

For people who have an anxiety disorder, worry and fear are constant and overwhelming, and can be disabling. With the correct treatment, most can overcome the anxiety disorder and lead a fulfilling life.

Types of Disorders

Anxiety disorder is a broad category that includes:

Panic Disorder. Feeling overwhelming sense of terror or dread that seemingly strikes randomly. During a panic attack, the person may sweat, have chest pain, and feel unusually strong or irregular heartbeats. Sometimes they may feel like they’re choking or having a heart attack.

Social Anxiety Disorder. Also known as Social Phobia, this is when someone feels overwhelming worry or judgement while in social situations. They may obsess over others judgment or being embarrassed or ridiculed.

Specific Phobias. This is when someone has a very specific fear of something such as spiders, heights or flying. The fear goes beyond what’s appropriate based on actual risk and may cause them to avoid regular situations.

Generalized Anxiety Disorder. This is what I see most when working with college students. They describe having excessive, unrealistic worry and tension with little or no reason.

Risks

Early signs of anxiety are super subtle and include distractability, avoidance and sleeplessness. Students with anxiety disorders often report to me that semesters generally start fine but as papers, tests and social pressures mount, their anxiety builds to the point where they start consider drastic changes like dropping out of school. Untreated anxiety can lead to depression, severe drug use and in some instance, suicide. Anxiety and depression seem to be best friends, often presenting together in college students I’ve worked with.

What to Do

Though anxiety disorders can make someone feel hopeless, there are very effective treatments and interventions we can implement to get their life back on track. Here are the 7 I think are most important for parents to be aware of if they need help with their college kid.

1. Counseling

Right out of the gate, the first thing parents should do is link their child with a) campus health services (often called Counseling and Psychological Services or CAPS) and b) a therapist or counseling like me specializing in college student anxiety in the community close to campus. Ideally, find a therapist/counselor that uses Cognitive Behavioral Therapy (CBT) or Dialectical Behavioral Therapy (DBT). Waiting until the first big meltdown could be too late. Loads of freshman fail to share their struggles with their parents until Thanksgiving and Christmas which, by then, is too late in their minds and they end up not returning for their Spring semester. Invest the time on the front end.

2. Scheduling

Anxiety is fed by fear. Fear is often the by-product of lack of predictability about social events, academic outcomes, and career failures. One solution is increasing predictability. I accomplish this with students by teaching them to download the semester schedule onto their phone calendars before the semester starts. Next, after they’ve received their syllabi, I coach them to put in every single date for every single assignment/test possible. This also includes social events and any non-academic stuff they know about. This may sound like it could be overwhelming, but I’d rather have them feel a bit overwhelmed when looking at the calendars rather than anxious about remember when that next big thing is due.

3. Resources

Not the most used suggestion but one we have to put here – make sure your son or daughter has a list or access to resources that can help them reduce stressors or mitigate things when they’re already starting to spiral down. These resources could include the academic supports found at nearly every university or within the community. Universities have a vested interest in making sure your son or daughter doesn’t bail at semester’s end. Another form of ‘resource’ is the on-call list. Create a formal or informal list of people they can call/text when they are starting to feel overwhelmed. I am on-call for all of my clients and often receive texts from students the night before big tests asking for help in quiet their brains down. I call them or text back strategies and remind them to call if they want to talk through things in more detail. Just knowing there is a safety net and team of support can have a dramatic reduction effect on anxiety.

4. Medication

I am super conservative with medication use and recommendations for students I work with at Indiana University. But, with that said, we also recognize that some folks simply need a bit more support than what counseling and academic support can provide alone. If your college does not have a psychiatrist on staff, we highly recommend finding one in the local community. We rarely encourage use of primary care physicians or nurse practitioners for medication management since they are not specifically trained to diagnose and medically treat those suffering from anxiety. You also want your college kid to work with someone who genuinely understands the risk of some medications that have the potential for addiction. Good kids get hooked on meds the same as bad kids. It’s also important to avoid illegal or non-prescribed drugs (like the roommate’s Xanax).

5. Meditation

I recommend to nearly every client to start participating in weekly yoga, meditation or mindfullness classes. This is an evidence-based approach with only positive side-effects. Plus, every college offers these in their wellness programs for free so encourage your kid to take advantage and put it into the calendar. Meditation, counseling and medication are an incredibly complimentary approach to combating anxiety.

6. Sleep

Not easy when kids have more freedom than ever away from home but we nonetheless push parents to encourage sleep. Not binge sleeping but a healthy 8 hours per night. The ideal for anxiety reduction is a steady sleep pattern so that bedtime and wake time are pretty standard every day. Staying up late on Thursday, Friday and Saturday, sleeping in till 1:00pm and then dragging out of bed Monday morning for an 8:50am class is terrible for anxiety. Sleep meds only make things worse and really should only be taken with the psychiatrists oversight.

7. Exercise

Encourage your kid to sign up for the intramural leagues, especially for sports where there is little standing around time. Distraction and flow experience are essential in helping him or her focus on non-academic activities. It’s also a great way for them to be social without needing a drink in their hand.

Ok folks. Hope this helps you figure out the best way to help that college kid who may be struggling as you’re getting through the fear of letting go. It’s an exciting time and, with the right strategies in the beginning, can be the start to a fantastic semester.

By the time kids turn 18, they average over 10 hrs of device time per day. While that represents a huge chunk of time, not all of it is necessarily wasted time. Technology is more social than you realize; more pervasive than you realize; bigger problem than you realize. Technology is not good or bad. It’s a tool that needs to be used, limited and controlled.

Parental Control. Apps that control devices, apps that control other apps, device control (remote and local), monitoring devices before something bad happens lets you kid know you are watching. Parental-control apps for mobile devices work best when they’re part of a comprehensive approach to teaching your kids about behaving responsibly online. That means talking to your kids about what they should and shouldn’t do with their mobile devices and clearly communicating how you expect them to act.

Tech solutions are great, but nothing can replace a relationship based on trust and boundaries. For that reason, I avoided apps that only run in stealth mode on your child’s phone. Products such as WebWatcher and mSpy both tout this capability. I also did not consider apps that offered the ability to record phone conversations, since state laws vary on the legality of recording someone without his or her consent.

Parent Control Apps

So your kids have somehow made it to adolescence. Now, it’s time to manage how they use devices. On the one hand, giving them free-reign over their swanky iPhone evokes the fear of God in you. But you also don’t have the time or interest in acting like the CIA/NSA and monitoring every bit of data that flows to and from their device.

The middleground is a reasonable parental control app or, at a minimum, parental controls within the settings of the device. While we are about a decade into the smartphone lifestyle, we are only a few years into parental controls that strike that balance between independence and oversight. Below, I’ve created a list of things to look for when researching parental control apps. New apps will come and old ones will disappear, but the list below of qualities to look for should stand the test of time. Here is a comprehensive list of what you’ll want to see in a good quality parental control app:

Installation. How easy is it to install and setup each app on a smartphone? How hard is it for your kid to uninstall?

App Management. Since most of the time spent on smartphones is within an app and not a browser, which program lets you review all the apps on a device and block or limit app usage? Does it control native apps (eg. iMessage for iPhones)?

Filtering. What tools does each app offer and how well did they do at restricting access to inappropriate content online?

Texting Management. With kids doing most of their communicating through texts these days, we looked at the features for monitoring messaging. Do the apps let you review the content of your child’s texts? Can you block a contact and be alerted when your child adds a new contact? Can you block messaging apps altogether?

Location tracking. Does the app keep a log of where your child has been — and more importantly — give you the ability to locate your child in an emergency?

Price. How much will the service cost annually? How many devices can you control? Does the app company upsell you later on?

Gaming. More social than you think, Needs to be limited (time), Needs to be viewed as privilege rather than right or default. Gaming, just like any other activity, should be limited. Gaming is definitely more addictive than sports or other socially acceptable interests. First of all, game designers hire psychologists and create a sticky environment – they make it really, really tough to walk away. Free gaming apps? Even worse since their business model is dependent upon eyeballs on ads and in-app purchases. Games for XBox have a different business model – give away (or sell cheaply) the game system and sell the expensive game. Then their are the in-game purchases. Secondary income stream.

Social Media Monitoring/Control. Do the services allow users to monitor activity on social media. You either need to “root” a device – which is not recommended. It’s easier and healthier for your relationship to just have your child hand over his or her usernames and passwords.

Solutions

Let’s get to the good stuff – the apps and services that you can use to oversee your kid’s tech usage. I’m sure that by the time this is published there will be a million other ones, but for now, here are some top rated monitoring apps:

Not all apps or tech need to be about Orwellian parenting. The apps I’ve listed below provide varying degrees of reward and consequence to modify screen time or limit use of certain apps. The theme here is promoting non-screen time.

Pocket Points. Pocket Points is an app that middle school, high school and college students can download onto their phone or iPad. Once students open the Pocket Points app and lock their phone, they start to accumulate points. The longer their phone stays locked, the more points they can get. Points are also awarded based on how many people are on the app at a time. The app is free and only works on a campus that’s identified by Pocket Points. Students can redeem their points for free or discounted items from local vendors. https://pocketpoints.com

Offtime. This app helps students unplug by blocking distracting apps like Instagram and games and filtering communications. It provides data on how much they use their device. A more customized mode like Work, Family, or Me Time can be turned on to ensure that they have access to the necessary things apps, but aren’t distracted by the junk. http://offtime.co/

Moment. Moment tracks student’s phone usage and allows them to set daily limits; the app notifies them if exceeded. They can even use a setting that “forces” them off the phone by flooding the screen with annoying alerts when trying to extend screen time (what a cruel app). Moment can easily be used for families, with the option to track device use from a parent’s phone. https://inthemoment.io/

BreakFree. BreakFree has a usage tracker found in similar apps, but it differs in that it breaks down the information into a super simple addict score (yikes, that’s pretty harsh). It shows kids how often they unlock their screens, and logs every bit of their usage for the day. This app is a great option for students who like to set goals and challenge themselves. Ironically (maybe, intentionally…) it can be addictive to try to see how low students can get their addict score. Oh, the humanity. http://www.breakfree-app.com/

Flipd. Can’t app developers spell things normal? Flipd is the poorly-spelled and dialed-up aggressive app for your kid if they are not so easily encouraged to curb device time. Flipd allows you to lock a phone for a set period of time, and once you do, there’s no going back. Even restarting their phone won’t disable the app, so it’s impossible for them to find a work-around. Flipd can even be used to remotely “flip off” one user from another user’s device, which is helpful for teams that want to keep one another on point. I’m thinking it would be helpful for parents to have this app for kids that just can’t say no and grades are dropping. http://flipdapp.co/

AppDetox. Is your kid a gamer? Are they addicted to checking Instagram? AppDetox can help them get their fixation under control if apps are too addictive, but their not quite ready to give them up. You and your above-average kid can set your own parameters on an app-by-app basis providing access when it’s not a potential disruption. Every time your kiddo breaks one of his or her own rules, the app reminds you to put down your phone. Could be helpful for students that are well-intentioned and need that extra reminder occasionally. https://play.google.com/store/apps/details?id=de.dfki.appdetox&hl=en

Stay on Task. How’s that for a blunt name? Stay on Task helps your productivity in a gentler way compared to some of the other aggressive time overlords. The app provides a gentle prompt, asking if you’re still on task at random times during your day. If your college student is someone who easily gets distracted, this app can be a great way to redirect their focus when another post popped up and their mind is wandering. https://play.google.com/store/apps/details?id=valavg.stayontask

Of all the issues parents bring to me needing help with, one of the more challenging is what to do about a kid who’s smoking pot. There are legal issues, family’s values, and the impact on academics and social group. It’s tempting to be black and white by having a strict policy at home, but things can get complicated to the point that binary thinking does not work. Here are some thoughts I have parents consider which can inform how to handle specific situations as well as bigger family value decisions:

1. Determine Risk: A kid who is generally doing well in school and seems pretty solid generally poses less risk for potential problems than a kid with a family history of substance abuse, depression or in the middle of a family chaos. If your son falls in the high risk category, get professional help from a therapits/counselor. If your son/daughter is really falling off the cliff, work with a therapeutic placement consultant or education consultant to find a residential treatment program.

2. Provide Reasonable Consequences: If there is no family history of substance abuse issues and you are certain that your son/daughter is generally doing well at school, at home and with friends, focus on keeping the lines of communication open. If your kid is afraid of your reaction, it’s unlikely that s/he will continue to confide in you. Consequences may simply encourage him/her to become better at hiding any future use from you. Sometimes, though, there is a serious enough violation of family rules or trust and a consequence needs to be given. If you do administer a consequence, make it proportional to the violation. I go into more detail about effective consequences in this blog post.

3. Improve Communication: When we validated, understood and loved by someone our instinct is to share our thoughts and feelings, even if we feel uncomfortable about judgment. Thought kids often push us away, it’s essential to look for ways to keep connecting in authentic ways. The more they feel anchored to you, the less negative influence his/her friends will have. What if your kid says they really liked smoking pot? Don’t freak out – discuss why drugs and alcohol make people feel good (don’t preach). Explain the way the brain works (Google it if you don’t know), and the temporary impact these substances can have on lowering anxiety or improving our mood. Another angle is to ask if they would be open to listening to your concerns (again, no preaching…just your fears/concerns). Explain that while you understand “everyone” may be smoking weed or drinking (they are, trust me), the stress relief many experience can quickly become at least psychologically addicting, and that there are better ways of handling stress.

4. Role Model: Consider what your son/daughter sees you doing to relax at the end of the day, or when you socialize with your friends. If you have a glass of wine the minute you get home from work or immediately open a six-pack when friends show up, you teaching your kid that fun and/or relaxation cannot happen without some kind of substance. Show them you can enjoy life without leaning on something to help you chill out when life gets tough.

5. Keep Your Radar On: If you start to sense that their use has increased beyond normal stupid-teen-use, establish expectations that send them a clear message that it is not okay. As a teen, a kid’s brain is still in a vulnerable and formative stage. It’s the parent’s responsibility to help him/her make healthy choices. Some kids tell me they actually appreciate it when their parents tell them that they might start drug testing. It makes it way easier to say no to their friends, “I can’t… my parents are drug testing me.”

6. Search and Seizure: Of all the messy things about drug use, the hardest one for me to cover with parents is looking through a kid’s phone, room, car and bags. On the one hand, we want kids to have a sense of autonomy and independence. We want them to have a safe place where they can let their guard down. On the other hand, if a kid is using drugs and bringing them home, parents need to know and set a boundary. Another complicating factor is that most kids are pretty good sneaks…they hide stuff well so even if you tear their room apart they’ll likely still have pot stashed somewhere (maybe even at a friend’s house). Pot in the house is like the dandelions in my backyard. I can pull each one of them up and be vigilent but until I’m able to a) destroy all the dandelions and their seeds in the entire neighborhood or b) build a huge bubble around our property, I will never conquer them. I need to either get to the source of the problem or do my best to keep them controlled so they don’t take over the yard. If you do find pot or paraphernalia, it’s fine to have a meeting/conversation with them and explain the rules about no pot use, no pot at home and no pot in the car. If any of those are violated, they’ll receive a consequence. If they appear to have a more severe issue, a professional will be contacted and possibly a higher level of care pursued.

Most kids have plenty of opportunity to use alcohol and pot. But while it’s likely that them will be offered the chance to try illegal drugs, it is not a good idea for parents to look the other way. Teens and college students still need parents to help them make good choices (even if they will not appreciate it or ask for it). Acting like it’s no big deal can send a confusing message to a kid who might not want to drink every weekend, but may not know how to handle the pressure to do so.